Inter-Examiner Agreement of the National Upper Cervical Chiropractic Association Analysis of the Atlas Subluxation Complex in a 3-View Upper Cervical Radiographic Series.

Objective: The purpose of this study was to measure the inter-examiner agreement between radiograph markings of 2 National Upper Cervical Chiropractic Association board-certified chiropractors. Methods: Two chiropractic examiners who had standardized training marked and analyzed 254 conventional orthogonal radiographic film sets. The level of agreement and potential biases in their measurements were assessed using intraclass correlation coefficients for absolute agreement and Bland-Altman plot analyses. Results: There was 96.1% agreement between the examiners in the measurements of the side of atlas laterality and 94.5% for atlas rotation. The intraclass correlation coefficient was 0.95 (95% CI, 0.93-0.96) for atlas laterality and 0.92 (95% CI, 0.89-0.94) for atlas rotation. The mean difference in the measurement between the 2 examiners was -0.11, P = .12 for atlas laterality and 0.05, P = .55 for atlas rotation. Neither atlas laterality nor atlas rotation measurements were significantly different from zero. Bland-Altman plots were not suggestive of any proportional biases in the 2 measurements. Conclusion: Results of this study show almost perfect agreement between 2 trained chiropractic examiners, with no apparent proportional bias in the analysis of conventional orthogonal radiographic film sets.

Comparison of National Board of Chiropractic Examiners part I examination scores between tutors and tutees at a chiropractic college.

OBJECTIVE: This study compared National Board of Chiropractic Examiners part I test scores between students who did and did not serve as tutors on the subject matter. METHODS: Students who had a prior grade point average of 3.45 or above on a 4.0 scale just before taking part I of the board exams were eligible to participate. A 2-sample t-test was used to ascertain the difference in the mean scores on part I between the tutor group (n = 28) and nontutor (n = 29) group. RESULTS: Scores were higher in all subjects for the tutor group compared to the nontutor group and the differences were statistically significant (p < .01) with large effect sizes. CONCLUSION: The tutors in this study performed better on part I of the board examination compared to nontutors, suggesting that tutoring results in an academic benefit for tutors themselves.

Paraspinal skin temperature patterns: an interexaminer and intraexaminer reliability study.

BACKGROUND: Paraspinal thermography is used by chiropractors as an aid in assessing the presence of vertebral subluxation. Few reliability studies have been carried out, with mixed results. Digital infrared scanning equipment is now available with location tracking that may enhance reproducibility. Digitized scans enable a computer-aided interpretation of thermographic patterns. OBJECTIVE: To assess the ability of examiners to reproduce thermal patterns. STUDY DESIGN: Repeated measures with 2 examiners assessing the same patient on 2 occasions. Thirty asymptomatic students served as subjects. METHODS: A TyTron C-3000 handheld thermographic scanner interfaced to a Microsoft Windows compatible personal computer was used for all recordings. Each examiner recorded 2 scans on each patient. It took an average of 3 minutes to complete all 4 scans. Data were exported to a spreadsheet for initial analysis, then SPSS was used for calculation of intraclass correlation coefficients (ICC). Since the starting and stopping points of scans were not always the same, care was taken to align scans visually, using well-distinguished peaks on the charts as guides. Scans were cropped to remove artifacts that might have occurred at the beginning and end of the scans. Intraexaminer and interexaminer ICCs were calculated. RESULTS: Skin temperatures ranged from 35.4 degrees C to 30.0 degrees C over all scans. The average temperatures changed little from the first to the last scans, indicating that subjects' overall skin temperatures were stable during the scanning procedure. Intraexaminer ICCs ranged from 0.953 to 0.984. The left and right channel data show slightly higher congruence than the Delta channel. The interexaminer reliability coefficients ranged from 0.918 to 0.975. Again, the Delta channel shows slightly less reliability, although the ICCs were quite high for all channels. CONCLUSION: Intraexaminer and interexaminer reliability of paraspinal thermal scans using the TyTron C-3000 were found to be very high, with ICC values between 0.91 and 0.98. Changes seen in thermal scans when properly done are most likely due to actual physiological changes rather than equipment error.